Towards the dream of universal social protection: lessons from Pakistan's Ehsaas
Authors: Sania Nishtar, Imran Khan
Journal: The Lancet Global Health (2023)

40–60% of Pakistanis live in poverty.1UN Development ProgrammeIn Pakistan, pandemic could push millions more into poverty.https://www.undp.org/press-releases/pakistan-pandemic-could-push-millions-more-povertyDate: June 18, 2020Date accessed: March 20, 2023Google Scholar, 2The World BankPakistan development update report.https://thedocs.worldbank.org/en/doc/5ee854aff2b120cb30ef910f4e7421f9-0310012023/pakistan-development-update-report-april-2023Date: April 2023Date accessed: March 20, 2023Google Scholar During our time in government (from August, 2018, to April, 2022), we began a journey towards establishing a welfare state through the Ehsaas initiative, which comprised 16 nationwide programmes—including cash transfer initiatives, care services, poverty graduation, and targeted subsidy programmes (appendix p 2).3Barber SM Shahzad M Frameworks for a developmental welfare state: lessons from Pakistan's Ehsaas programme.https://fsi.stanford.edu/publication/frameworks-developmental-welfare-state-lessons-pakistans-ehsaas-programmeDate: June 6, 2022Date accessed: August 3, 2022Google Scholar The number of families receiving social protection and budget were trebled with Ehsaas, reaching 15 million families. Governance reforms,4EhsaasEhsaas Building and Rebuilding Institutions Initiative.https://static1.squarespace.com/static/63356bb01701076f4c3626cc/t/644002d33b13897ccdb6542d/1681916654744/BRI+Report.pdfDate accessed: April 21, 2022Google Scholar a digital survey covering 34 million households,5@SaniaNishtar https://twitter.com/SaniaNishtar/status/1514183896014938112Date: April 13, 2022Date accessed: April 11, 2023Google Scholar and the fastest COVID 19-related cash distribution,6Federal Bureau of StatisticsSpecial survey for evaluating socio-economic impact of COVID-19 on wellbeing of people.https://www.pbs.gov.pk/sites/default/files/other/covid/Final_Report_for_Covid_Survey_0.pdfDate: 2020Date accessed: March 20, 2023Google Scholar globally were also executed. The vision of Ehsaas was to achieve social protection for all by 2047, Pakistan's 100th independence anniversary.7Nishtar S. Delivering at scale: insights from Ehsaas. Oxford: Oxford University Press (in press).Google Scholar During execution, low digital literacy, capacity issues, and vested interests, remained obstacles. Important implementation lessons were learnt. First, social protection has traditionally been used by governments and parliamentarians for political patronage. Conversely, Ehsaas targeted funds based on need and merit, building safeguards against abuse and political capture.8Shahzad M Anwar S Siddiqui R Barber M Delivery associatesThe Ehsaas programme report.https://www.deliveryassociates.com/media/ehsaas-programme-reportDate: 2020Date accessed: August 7, 2023Google Scholar Data and digitisation were enablers. For example, during the execution of COVID-19 Ehsaas Emergency Cash, we used SMS short code for applications, data analytics for targeting, SMS for eligibility notifications, and real-time biometrics for payment verification. 15 million deserving families (nearly 100 million people) were served, rather than cronies of the powerful.6Federal Bureau of StatisticsSpecial survey for evaluating socio-economic impact of COVID-19 on wellbeing of people.https://www.pbs.gov.pk/sites/default/files/other/covid/Final_Report_for_Covid_Survey_0.pdfDate: 2020Date accessed: March 20, 2023Google Scholar To this date, some parliamentarians resent losing this political patronage tool. Previous manual surveys were prone to political capture. The end-to-end digital survey and data analytics helped prevent abuse. Around 850 000 undeserving individuals were also removed from the government's previously used social protection lists.9Pakistan StandardOver 800 000 BISP beneficiaries to be 'exited'.https://www.pakistanstandard.com/over-800000-bisp-beneficiaries-to-be-exited/Date: Dec 26, 2019Date accessed: March 20, 2023Google Scholar The lessons learnt centre on the importance of data, digitisation, and rule-based processes to run politically neutral social protection operations. Leadership in every country must be committed to this. Second, cross-sectoral collaboration is crucial for delivery systems. Ehsaas' execution entailed multiple dependencies on government entities, and it was through a concerted effort that we built collaboration. However, there are no formal incentives for collaboration within government. The lesson is that we need new competencies to forge multisectoral collaboration, such as intermediary agencies, incentives for collaborative division of labour, and metrics for whole-of-government performance assessment.10Nishtar S Reflections from my tenure as a minister.Lancet. 2014; 385: 910-913Summary Full Text Full Text PDF Scopus (1) Google Scholar Third, we learnt that building the system isn't the end. Effective implementation and delivery is key.11Barber M How to run a government: so that citizens benefit and taxpayers don't go crazy. Penguin Books, London2015Google Scholar However, the challenge is that, within government, accountability-for-delivery is not institutionalised. We established a dedicated delivery unit (the first in a Pakistan Government ministry) to execute the multicomponent Ehsaas and institutionalised a review process; this included workplans, quantifiable metrics, tracking tools, dashboards, and meeting cadences. Important lessons were learnt about delivering a multicomponent programme within the government system. Fourth, we must insulate programmes from the policy vacillation, a norm inherent to change in government, rather than an exception. Governments must be held to account when they deviate from evidence and when long-term policy consistency is needed, multi-partisan consensus should be mandated. Fifth, in Pakistan, anti-corruption measures are largely punitive and post-hoc, while evidence shows that the key is to focus on building institutions and systems that limit opportunities for corruption.12The World BankEnhancing government effectiveness and transparency.https://documents1.worldbank.org/curated/en/986521600118147288/pdf/Executive-Summary.pdfDate: 2020Date accessed: March 20, 2023Google Scholar To curb corruption in social protection, we promoted respect for merit, integrity, ethical conduct, governance by the book, adherence to rules, checks and balances, elimination of discretionary powers, safeguards against conflicts of interest, digitisation, and systems such as internal audits, cyber-vigilance, electronic filing, and business intelligence tools. The lesson here is that systems are needed to curb corruption and that setting a personal example is crucial. Finally, we learnt that social protection can also be used to achieve other objectives, such as climate resilience, government digitisation, targeting of subsides, human capital development, livelihood creation as well as the promotion of women empowerment, universal health coverage, and the local economy. Beyond its value as a platform to deliver on the dream of resilient social protection for all in Pakistan as outlined in the Ehsaas Vision 2047,7Nishtar S. Delivering at scale: insights from Ehsaas. Oxford: Oxford University Press (in press).Google Scholar Ehsaas' execution offers insights for other countries in view of several recent crises, which have unearthed an opportunity to recast the role of the welfare state. We clearly have an opportunity to create an historic inflection point to promote social welfare, globally. SN is a Senator and former Special Assistant to the Prime Minister of Pakistan. IK is a former Prime Minister of Pakistan. 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